Treating your thyroid nodule by percutaneous
radiofrequency ablation (RFA)
Introduction
This leaflet tells you about the procedure known as “percutaneous radiofrequency ablation” and will explain what is involved, including the benefits and possible risks. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such a discussion. Further sources of information are suggested at the end of the leaflet.
Benign (non-cancerous) thyroid nodules
Thyroid nodules are a very common cause for a lump in the neck. The vast majority are confirmed to be benign by tests including an ultrasound and a needle test (fine needle aspiration or FNA). A few of these benign nodules grow to a size that can cause local symptoms such as pressure or pain or become unsightly to an individual. Radiofrequency ablation is a treatment option for these types of nodules.
How are benign thyroid nodules normally treated?
Benign thyroid nodules can be left alone if they are not causing symptoms which are troublesome to the patient. When treatment is required the standard option is surgery with removal of either part of or the whole thyroid gland. Surgery is not suitable for all patients. Some patients may not be fit enough for surgery and others may not wish to undergo a surgical procedure.
What is percutaneous radiofrequency ablation?
“Percutaneous” means through the skin and ablation means destruction (of tissue). “Percutaneous radiofrequency ablation” (or RFA) is therefore a technique where radiofrequency energy (an electric current) is used to generate heat to destroy tumour cells. The energy to heat the tissue is delivered through thin needles (also called electrodes). These needles are inserted through the skin into the tumour under local anaesthetic with ultrasound guidance.
Thyroid nodule percutaneous radiofrequency ablation (RFA), December 2019 1
Treating your thyroid nodule by percutaneous radiofrequency ablation (RFA)
Why am I being offered percutaneous radiofrequency ablation?
Percutaneous radiofrequency ablation is now an approved procedure for the treatment of benign thyroid nodules (or tumours) by the National Institute for Health and Care Effectiveness (NICE). Evidence shows it to be safe and effective in shrinking thyroid nodules.
RFA should be considered in patients who are unsuitable for high risk surgery or wish to avoid having surgery for their benign thyroid nodule. Your consultant will be considering this procedure for you only after a detailed clinical assessment. This will include an ultrasound scan, needle testing the nodule (sometimes on more than one occasion) and, of course, after discussion with you. Your consultant will also explain the alternatives including surgery or simply monitoring the nodule if symptoms are not sufficiently troublesome.
There are benefits and risks related to any treatment option and these will be explained in detail when you are consented for the procedure.
Benefits of percutaneous radiofrequency ablation
· Less invasive procedure than surgery.
· Performed under local anaesthetic.
· Performed as a day case rather than overnight admission for surgery.
· Shorter recovery time than surgery.
· Avoids a surgical scar.
· Low rate of complications.
· Preserves thyroid function, avoiding the need for thyroid replacement tablets (Thyroxine).
Risks of percutaneous radiofrequency ablation
· All treatments and procedures have risks and these will be discussed in detail with you by the doctor.
· Serious complications are rare. The main risks are bleeding, hoarse voice due to nerve bruising, skin burns and infection. Infection can be a delayed problem and present with swelling, pain and redness.
· Rare serious complications include damage to the food pipe (oesophagus), wind pipe (trachea) and nerves to the voice box (vocal cords). The risk of permanent injury to the voice box nerve leading to alteration in the voice is less than 1% (less 1 in 100 chance).
· Unlike surgery larger nodules could require more than one treatment for effective nodule shrinkage. The doctor can discuss this individual risk with you
Who will be doing the percutaneous thermal tumour ablation?
An interventional radiologist performs the procedure, and works closely with the ENT surgeon both in ensuring your suitability and in assessing the result of treatment.
Thyroid nodule percutaneous radiofrequency ablation (RFA), December 2019 2
Treating your thyroid nodule by percutaneous radiofrequency ablation (RFA)
Where will the procedure take place?
The procedure is performed in the X-ray Department in the Ultrasound room.
How do I prepare for percutaneous thermal ablation?
You will be given an appointment to attend a pre-procedural consultation. All preparation details will be discussed with you and you will be able to ask questions of your own. We may also carry out some blood tests.
